In recent years there has been increasing recognition by doctors as well as patients that psychological stress can worsen the course of inflammatory bowel disease (IBD).1^–3 In this issue, Bitton et al (see page 1386) report that the way in which some patients cope increases the risk of relapse of their Crohn’s disease after 1 year4: in other words, the wrong sort of coping can be bad for your health.

STRESS AND COPING

Stress can be defined as a threat, whether physical or psychological, to an organism’s homeostasis.5 The term coping describes the thoughts and behaviours used to manage the internal and external demands of situations that are perceived as taxing.6 Coping theory states that an individual’s ability to deal with stress depends both on their coping resources and on the strategies they employ when stressed. Resources include not only the social support a patient has, but also their stable personality traits: people who cope well are optimistic and have a strong sense of self-control and high self-esteem.7

Coping strategies have been variously classified and may change with the passage of time. Commonly quoted categories of coping behaviour, which are not mutually exclusive, include problem-solving, emotion-oriented, avoidance-oriented and supportant (table 1).8^–11 While most gastroenterologists will have experience of questionnaires for assessing patients’ psychological state and perceived stress levels,12 fewer will be familiar with those devised to identify people’s coping strategies.13

A recent meta-analysis examining coping strategies in health and disease returned heterogeneous results, but in general emotion-focused strategies such as distancing and avoidance were negatively associated with health outcome, while problem-solving approaches were more beneficial.9 It is possible that, by attempting to problem-solve, an individual may reduce the length or intensity of the stressor, and the consequent psychoneuroimmunological …